Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries

Jeffrey R. Curtis, Andrew J. Laster, David J. Becker, Laura D Carbone, Lisa C. Gary, Meredith L. Kilgore, Robert Matthews, Michael A. Morrisey, Kenneth G. Saag, S. Bobo Tanner, Elizabeth Delzell

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5% national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3% for women and 9.1% for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19% and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at <23 mo, the proportion of claims denied ranged from 2% to 43%, depending on Medicare carrier. Denial of Medicare reimbursement for DXA varies significantly by sex, time since previous DXA, ICD-9 diagnosis code submitted, place of service (office vs facility), and local Medicare carrier. Greater guidance and transparency in coding policies are needed to ensure that DXA as a covered service is reimbursed for Medicare beneficiaries with the appropriate indications.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalJournal of Clinical Densitometry
Volume11
Issue number4
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

Fingerprint

Photon Absorptiometry
Medicare
Bone Density
International Classification of Diseases
Current Procedural Terminology
Physicians' Offices
Health Maintenance Organizations
Logistic Models
Bone and Bones

Keywords

  • Bone mineral density
  • dual-energy X-ray absorptiometry
  • epidemiology
  • osteoporosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries. / Curtis, Jeffrey R.; Laster, Andrew J.; Becker, David J.; Carbone, Laura D; Gary, Lisa C.; Kilgore, Meredith L.; Matthews, Robert; Morrisey, Michael A.; Saag, Kenneth G.; Tanner, S. Bobo; Delzell, Elizabeth.

In: Journal of Clinical Densitometry, Vol. 11, No. 4, 01.10.2008, p. 568-574.

Research output: Contribution to journalArticle

Curtis, JR, Laster, AJ, Becker, DJ, Carbone, LD, Gary, LC, Kilgore, ML, Matthews, R, Morrisey, MA, Saag, KG, Tanner, SB & Delzell, E 2008, 'Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries', Journal of Clinical Densitometry, vol. 11, no. 4, pp. 568-574. https://doi.org/10.1016/j.jocd.2008.07.004
Curtis, Jeffrey R. ; Laster, Andrew J. ; Becker, David J. ; Carbone, Laura D ; Gary, Lisa C. ; Kilgore, Meredith L. ; Matthews, Robert ; Morrisey, Michael A. ; Saag, Kenneth G. ; Tanner, S. Bobo ; Delzell, Elizabeth. / Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries. In: Journal of Clinical Densitometry. 2008 ; Vol. 11, No. 4. pp. 568-574.
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abstract = "Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5{\%} national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3{\%} for women and 9.1{\%} for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19{\%} and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at <23 mo, the proportion of claims denied ranged from 2{\%} to 43{\%}, depending on Medicare carrier. Denial of Medicare reimbursement for DXA varies significantly by sex, time since previous DXA, ICD-9 diagnosis code submitted, place of service (office vs facility), and local Medicare carrier. Greater guidance and transparency in coding policies are needed to ensure that DXA as a covered service is reimbursed for Medicare beneficiaries with the appropriate indications.",
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